Prenatal care experiences of first-time mothers navigating socioeconomic challenges during pregnancy in New Brunswick: a qualitative descriptive study

Abstract

Background

Mothers facing socioeconomic challenges encounter substantial barriers to consistent, quality prenatal care, essential for reducing adverse birth outcomes. This study explores the barriers and facilitators to accessing prenatal care experienced by socioeconomically disadvantaged first-time mothers in New Brunswick, Canada.

Methods

A qualitative design was used to examine prenatal care experiences among first-time mothers facing socioeconomic disadvantage in New Brunswick. Participants were recruited between February and March 2024 through community organizations, including Family Resource Centres, using purposive sampling. Semi-structured interviews were conducted, transcribed, and analyzed thematically using NVivo 14.

Results

Four key themes emerged from the experiences of 11 participants: (i) structural challenges and discontinuity disrupt prenatal healthcare delivery; (ii) social and physical distance constrain access to prenatal services; (iii) prenatal care experiences amplify the emotional dimensions of pregnancy and birth; and (iv) relational interactions shape prenatal service access and quality. Participants described systemic issues including provider shortages, fragmented care, and long wait times. Geographic barriers particularly affected rural participants, creating travel burdens and limiting service access. Emotional dimensions of care were influenced by provider interactions, with negative experiences eroding trust and positive interactions providing emotional anchoring. Informal networks and community-based organizations served as critical facilitators, providing accessible support and bridging gaps in formal systems.

Conclusions

Socioeconomically disadvantaged first-time mothers face compounding barriers to prenatal care in New Brunswick. Addressing these disparities requires integrated public health approaches that coordinate care across providers and settings, expand community-based services, and reduce geographic and financial barriers. Participants relied primarily on informal networks and community organizations rather than formal programs, highlighting needs for improved outreach and service integration to better support vulnerable mothers during pregnancy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-025-08150-6.

Background

Mounting evidence shows adverse birth outcomes are disproportionately concentrated among mothers in the most socioeconomically disadvantaged groups [1]. Care provided during the prenatal phase is essential in narrowing such disparities, as it plays a key role in reducing risks and complications by providing essential screening, emotional support, education, and resources, thereby bolstering health outcomes for mothers and their infants [2–5]. In Canada, young women with less than high school education or living in lower-income households are more likely to experience stressful life events during their pregnancy and delay the start of prenatal care [6, 7]. These circumstances deriving from socioeconomic disadvantage often intersect with other maternal factors, which further amplify risk for adverse outcomes and complicate prenatal experiences, including young birthing age, limited health literacy, depression, exposure to trauma, and compromised preconception health [8–11].

Socioeconomically disadvantaged mothers face multiple barriers to accessing quality prenatal care. In the United States and the United Kingdom, evidence suggests that low-income mothers encounter structural barriers to their prenatal care, such as lack of provider continuity and transportation challenges, as well as individual-level factors like limited reproductive knowledge, and thus, obstruct timely access to services [12, 13]. Geographic factors further compound these challenges, as evidence from France demonstrates pregnant women in rural and remote areas face greater neighbourhood deprivation and have more limited access to prenatal healthcare resources [14]. These compounding challenges are shown to place mothers at higher risk of adverse pregnancy outcomes compared to their urban counterparts [15]. Transportation issues particularly affect prenatal engagement; whereby inconsistent attendance is often associated with living in areas dependent on public transportation with long transit times [16].

Canadian research highlights the negative effects of socioeconomic disadvantage on access to midwifery care [17] and inverse socioeconomic gradients for adverse birth outcomes across urban and rural Canada [18] yet few Canadian studies have examined prenatal experiences from the mothers’ perspective. To date, no research has considered the prenatal experiences of socioeconomically disadvantaged first-time mothers in Atlantic Canada, despite this region facing the highest levels of socioeconomic disadvantage in the country [19]. The Atlantic region (New Brunswick, Newfoundland and Labrador, Nova Scotia, and Prince Edward Island) experiences higher unemployment, higher energy poverty, slower economic growth, a declining workforce, lower female workforce participation, and reduced wages compared to the rest of Canada [20, 21]. In New Brunswick, income levels are among the lowest in the country, and child poverty rose from 18.7% in 2021 to 21.9% in 2022, representing the fourth highest rate among all provinces, with levels exceeding 30% in urban centres like Saint John, New Brunswick [22, 23]. Such socioeconomic conditions create substantial public health challenges for expectant mothers in the region, particularly for mothers already experiencing socioeconomic disadvantages, contributing to population-level disparities in maternal and infant health outcomes. It is imperative to understand how these compounded disadvantages shape their prenatal care experiences through evidence-based research that can inform program and policy development.

Given the persistent socioeconomic disparities in maternal and child health outcomes, targeted federal funding for provincial perinatal programs represents a foundational public health investment in reducing health inequities, particularly in economically disadvantaged provinces like New Brunswick. The province’s Healthy Families, Healthy Babies (HFHB) program, delivered by public health nurses and dietitians, provides free home visiting perinatal services – including home visits during the prenatal and postnatal stage – for first time pregnant and parenting families to promote healthy infant development from birth to age two. While existing research shows improved child development and health outcomes for mothers enrolled prenatally in perinatal programs [24] previous HFHB program-initiated research did not demonstrate the impact of the prenatal program and identified the necessity for more evidence on needs of the target population and barriers to prenatal enrollment [25]. By developing a better understanding of both the needs and the barriers and facilitators that affect prenatal service engagement among socioeconomically disadvantaged mothers, this research can help inform the development of targeted strategies to increase earlier enrollment and maximize perinatal program duration and effectiveness. This would provide continuity in support for mothers throughout the perinatal phase and help narrow persistent socioeconomic disparities in birth outcomes by ensuring those with the greatest needs can access perinatal support when it matters most.

This qualitative study describes the prenatal care experiences of socioeconomically disadvantaged first-time mothers in New Brunswick (defined as women experiencing their first live birth, regardless of previous pregnancy experiences). By identifying the barriers and facilitators encountered during pregnancy, this research reveals opportunities for enhanced health system integration and earlier engagement with perinatal support services. Addressing a critical knowledge gap in maternal perspectives from a region facing severe economic challenges, the findings aim to inform evidence-based program and policy development to improve maternal-child health outcomes for those most vulnerable to adverse birth outcomes.

Methods

Study design

The purpose of this research was to describe the prenatal experiences of socioeconomically vulnerable first-time mothers to inform public health interventions and policy development. As such, this qualitative study employs inductive thematic analysis to generate codes and identify emergent themes derived from participants’ responses from semi-structured interviews. The research adopts an interpretive paradigm, which recognizes reality as socially constituted and emphasizes understanding the subjective meanings participants construct from their lived experiences [26] thereby allowing for an exploration of how first-time mothers experiencing socioeconomic disadvantage make meaning of their prenatal care experiences within their social context. This study was conducted in the Canadian province of New Brunswick during February 2024 to March 2024 and was reviewed and approved by the University of New Brunswick Research Ethics Board (REB #2023 − 116).

Participants and recruitment

Participants were purposefully sampled across the province of New Brunswick, Canada, with a population of approximately 846,000 during the study period. Purposive sampling is a widely used sampling approach in qualitative research to identify information-rich cases related to the phenomenon of interest [27]. Homogeneous purposive sampling was used, selecting participants who shared the key characteristics of being first-time mothers experiencing socioeconomic disadvantage [28]. Within this homogeneous subpopulation, sampling allowed for variation in other characteristics (e.g., age, geography) to capture diverse experiences among participants meeting the inclusion criteria.

Inclusion criteria for participation included having had a baby for the first time in the last 18 months, being aged 16 and older, speaking English, and experiencing socioeconomic disadvantage. Consistent with established frameworks of social determinants of health [29–32] socioeconomic disadvantage was assessed through participants’ self-reported experience with financial hardship, food insecurity, educational challenges, housing instability, and loss or lack of social support.

Recruitment was conducted through each of the 13 Family Resource Centres (FRCs) in New Brunswick (a publicly funded group of organizations providing services to expectant parents and families with preschool children), as well as other community organizations such as food pantries, community centres, and supportive housing programs. These organizations referred potential participants either by providing their contact information to the research team (with permission from the participant) or by sharing the study recruitment information directly with them. Participants either contacted the research team or were contacted by email, followed by a phone call to review the consent form, answer questions, and schedule the interview. During this initial contact, participants completed a brief screening questionnaire to confirm they met the socioeconomic disadvantage criteria, though many were referred by organizations already familiar with participants’ circumstances. Participants received a $50 gift card to a local grocery or drug store of their choice as recognition for their participation. For those without mobile or internet access, community organizations assisted in organizing interviews, including coordinating free transportation to their facilities. It was anticipated that 10 to 15 participants would be recruited, acknowledging the inherent challenges of accessing this vulnerable population.

Data collection

The data collection and analysis followed a systematic process as outlined in Table 1, which summarizes the key procedural elements of the study methodology.

Table 1.

Data collection and analysis procedures

Step	Process
1. Consent	Consent form provided electronically in advance; written consent obtained prior to interview; verbal consent recorded at start of interview.
2. Interview Conduct	Semi-structured interviews were conducted via Microsoft Teams from February to March 2024 following an interview guide (Appendix A); approximately 30 min each.
3. Recording	Interviews video recorded with participant consent.
4. Transcription	Microsoft Teams transcription function used; accuracy verified by research team member who conducted the interview.
5. Storage	All data securely stored on password-protected SharePoint platform following REB-approved procedures and APA archiving guidelines.
6. Interview Structure	Stage 1: Open-ended questions about pregnancy experiences and care received. Stage 2: Questions about satisfaction with prenatal care. Stage 3: Questions about helpfulness of prenatal care received.
7. Analysis	Inductive thematic analysis conducted by two research team members; transcripts coded line-by-line; similar codes grouped to form themes.
8. Sample Size	11 participants recruited through purposive sampling until preliminary thematic patterns were identified.

Prior to interviews, participants were informed about the research topic, expected outcomes, and the importance of their participation. Ethical considerations were emphasized, including participants’ right to end the interview or withdraw from the study at any time without providing a reason. They were encouraged to pause or take breaks as needed, acknowledging the potentially emotional nature of discussing pregnancy experiences.

Interviews were participant-led and, while they may not have captured an exhaustive list of prenatal care services accessed, they broadly aimed to understand participants’ pregnancy journeys and the care they received. Rather than claiming theoretical saturation, this approach acknowledges sample size limitations while recognizing the value of the rich, in-depth data collected. Informed by Thorne’s critique of saturation claims in qualitative research [33] the analysis focused on identifying recurring patterns and themes that contribute meaningful insights to prenatal care for socioeconomically disadvantaged mothers in New Brunswick. This approach recognizes that the findings add depth and dimension to existing knowledge rather than reaching a definitive endpoint of understanding. Interviews were conducted in three stages: (1) open-ended questions about pregnancy experiences and care received, (2) satisfaction with prenatal care, and (3) helpfulness of prenatal care received. The interview guide, including specific questions used at each stage, can be found in Appendix A.

Thematic analysis

Inductive thematic analysis was conducted by two team members (LW and CR) following Braun and Clarke’s [34, 35] six-stage process for identifying emergent patterns and themes based on participants’ responses. They first read the interview transcripts multiple times to fully immerse themselves in the data, noting initial impressions and potential coding categories. Then they systematically sorted the data into meaningful units using NVivo 14, where the data was manually and inductively coded. To establish a robust analytical framework, one of the two team members thoroughly reviewed and coded the first three interviews to develop an initial codebook (see Supplemental Table 1). The initial codebook served as the foundation for the coding process and was updated throughout as new codes emerged, ensuring theoretical sensitivity to the data. When new codes were added, previously coded interviews were methodically reviewed and re-coded to maintain consistency and comprehensiveness across the dataset. While formal piloting of the codebook was not conducted, the iterative development and refinement process using the first three interviews served as an informal pilot phase. This approach allowed for testing and adjusting the coding framework while maintaining the inductive nature of the analysis.

The coding process employed a two-phase team member approach to enhance credibility and dependability: in the first phase, one team member analyzed half of the interviews, which were then independently reviewed and validated by the second team member. In the second phase, the roles reversed, with the second team member coding the remaining interviews and the first member of the research team independently reviewing and validating the results. This reciprocal validation process strengthened analytical rigor by minimizing risk of individual researcher bias. Discrepancies in coding interpretations were resolved through detailed discussion and consensus with the rest of the research team members, culminating in the generation of coherent thematic findings reflecting participants’ experiences.

Results

Sociodemographic characteristics of participants

Eleven first-time pregnant mothers participated in the study (Table 2). All participants self-identified as women. The age distribution included three participants aged 20 or younger, four participants between 21 and 29 years, and four participants aged 30 years and older. Six participants lived in one of New Brunswick’s three main urban centres while the remaining five participants lived in rural locations. Three participants had not graduated high school, four had completed high school, another two also completed community college, and two participants held bachelor’s degrees.

Table 2.

Participant demographic characteristics (n = 11)

Demographic Characteristics	N (%)
Female	11 (100%)
Age
≤ 20	3 (27.3%)
21–29	4 (36.4%)
30 +	4 (36.4%)
Geographic location
Urban	6 (54.5%)
Rural	5 (45.5%)
Education level
Less than high school	3 (27.3%)
High school diploma	4 (36.4%)
Community college	2 (18.2%)
Bachelor’s degree	2 (18.2%)

Participants were not directly asked about their housing, financial, or family status. However, more than half (n = 6) expressed that they had experienced housing instability during their pregnancy, including being unhoused, relying on informal housing support from family members, or accessing formal resources such as shelter housing. Seven participants similarly alluded to experiencing some form of financial strain during their pregnancy. Descriptions of familial support varied, ranging from fully supportive family members to those who were emotionally supportive but physically absent, and other family members who offered minimal to no support throughout the prenatal stage. Additionally, some participants mentioned their partner or other parent were absent during the pregnancy.

Use of prenatal services and supports

Participants described accessing a diverse array of medical, informational, and other support services throughout their pregnancies. Seven accessed care from a family doctor, though one participant lost access postpartum. The majority (n = 8) attended prenatal appointments at some point during their pregnancy. Some participants (n = 4) required specialized care, including consultations with maternal fetal medicine or other specialist consultations, for medical reasons.

In addition to formal medical services, participants relied on both informal and formal information and navigation services to gather information during their pregnancy. Informal information sources included the internet, podcasts, social media, online mom groups, and personal support networks such as friends and family members with children. Formal sources of information were accessed through community and resource centres, which often provided prenatal classes and a point of access to other services; however, not everyone had access to these resources due to limitations in availability and reach in certain areas.

Beyond medical and informational support, participants accessed a variety of other support services related to the need for income, housing, food, mental health, and social assistance. Five participants received income assistance, four accessed formal housing assistance, three used social work services, three accessed counselling, and one received support from community organizations (e.g., church, the Salvation Army, and a food pantry).

Thematic analysis

From the interviews, four major themes emerged regarding participants’ prenatal care experiences: (i) structural challenges and discontinuity disrupt prenatal healthcare delivery, (ii) social and physical distance constrain access to prenatal services, (iii) prenatal care experiences amplify the emotional dimensions of pregnancy and birth, and (iv) relational interactions shape prenatal service access and quality. Each theme is presented in Fig. 1 and described in the following sub-sections, using illustrative quotations verbatim from the interviews.

Fig. 1.

Four themes in prenatal care experiences

Theme 1: structural challenges and discontinuity disrupt prenatal healthcare delivery

Longstanding challenges in the formal healthcare system, including staff shortages and fragmented care delivery, coupled with financial constraints, created significant barriers to participants’ prenatal care experiences. About one third of participants indicated that they lacked a family doctor, prompting them to seek alternative entry points to prenatal care such as walk-in clinics or contacting the hospitals directly following at-home pregnancy tests:

We were unable to find a replacement doctor. You’re on your own after having a family doctor all these years, and now you don’t have one. So even for me, the lack of that family doctor, I had no one to go to, no one to talk to. I have the Maple app that I could reach out to [for online health consultations], but they can only do so much … (Participant 4).

Despite accessing care, participants continued to encounter persistent system-level barriers that undermined their access to prenatal care. Healthcare staff shortages and capacity constraints led to long wait times, service interruptions, and premature hospital discharges. For example, one participant who was unhoused during the onset of her pregnancy noted the long lead time for appointments with her obstetrician:

[I]f I called and said I had something wrong, like, not try to ignore it and say, like, ‘three weeks’ time’, just say, like, ‘I’ll see what I can do, I can put you on an emergency wait list’, like, I understand she has tons of patients and you can’t just get someone in immediately. But, like, a little bit of effort would have been nice. (Participant 10)

Beyond access delays and waiting times, financial barriers created additional systemic challenges that disrupted prenatal healthcare delivery. Some participants received medical recommendations but could not afford suggested treatments.

I was having a hard time walking…I don’t have health coverage to be able to go get physio massages, things like that, that would help that the doctors were suggesting. (Participant 4)

These financial constraints affected multiple aspects of care. Participant 1 noted: “I think if I had the money to hire a doula, [prenatal experience] would be better,” while Participant 8 simply stated: “Yes, because some things… it was very hard to afford… things are so expensive nowadays.” Such instances illustrate how socioeconomic disadvantage disrupts prenatal care by creating gaps between what is recommended or desired for optimal care and what participants can afford, preventing them from receiving comprehensive prenatal support.

Access to care and financial barriers were compounded by systemic discontinuity of care. Some participants (n = 3) emphasized encountering “new faces every time” at healthcare appointments or during medical procedures. Participants also expressed frustration at having to repeatedly reintroduce themselves and explain their medical situation to different providers. This inconsistency made it challenging to build relationships or establish trust with any single provider:

I did feel like because of, like, how it’s set up, it was really hard to kind of develop a relationship with your doctor. Because, you were, like, asking a new person questions each time. Didn’t feel comfortable really to ask questions because it was a new doctor you hadn’t seen before, so you kind of just had to trust, like, if there was something wrong and they would tell you. (Participant 3)

For participants already managing housing instability and financial strain, this lack of consistent provider relationships compounded existing socioeconomic barriers to receiving comprehensive care. Approximately half reported experiencing interruptions during service provision, including gaps in coordination, inconsistent information across providers, or repeated hospital visits without resolution, further contributing to feelings of disorganization and anxiety about gaps in their care journey.

In response to these systemic issues, some participants alternatively sought care from community-based providers or services, which they perceived as more accessible and responsive. For instance, Participant 9 described a negative experience with her family doctor that left her reluctant to return for care. Facing lengthy wait times to secure a new doctor, she chose to continue receiving care at a community-based health clinic instead: “And when talking to [Youth Engagement Services Staff member]….she will sit there if you have a problem…you can talk to her because she is kind of like a counsellor…” Similarly, another participant, unable to secure timely appointments with her obstetrician, chose to access medical care at a nonprofit organization where she had previously received health and social services.

These findings reveal how structural barriers create a cascade of disruptions that fundamentally undermine coordinated prenatal care delivery. While participants demonstrated agency in seeking alternative care sources, the necessity of these workarounds highlights gaps in healthcare system responsiveness to socioeconomically disadvantaged mothers, with implications for both care coordination and health equity outcomes.

Theme 2: social and physical distance constrain access to prenatal services

For socioeconomically disadvantaged mothers, geographic barriers to prenatal care were compounded by financial constraints that made travel costs prohibitive and limited their options for accessing services. Over half of participants noted physical and financial challenges related to the travel time required to access services:

It was just like how expensive it is to get an hour away from here to get to… a hospital, there is one in this area, but they don’t deal with labor and delivery so they’re not equipped. (Participant 4)

In some cases, the lack of healthcare facilities in participants’ rural locations meant that they had to travel regularly to larger centres to receive formal medical care:

… it’s hard when you’re pregnant, like physically, to be traveling by yourself or whatever for hours. And just to do, like, a short appointment. So yeah, it’d be nice if, like, some of those more remote rural communities could have some care for them as well. (Participant 2)

Additionally, the geographical distribution of prenatal services in New Brunswick created barriers for three participants, who were unable to access their desired level of care due to location constraints. Services such as prenatal classes, as well as access to a midwife and doula care, were often unavailable outside an urban area – for instance, Participant 3 lived in a rural town and was unable to access prenatal services in her community due to full classes: “…in the back of your head always wondered if it could have been that much of a better experience had you have been able to get into the [prenatal] classes.” Even when required or desired services were available, participants shared that the need for repeated visits or return trips posed physical and mental challenges:

I show up at the hospital the morning of after calling, confirming walk in, and then they said, ‘Oh, sorry, we double booked somebody else for an induction. Can you go back home and maybe come back tomorrow?’ And, like, already I’m 37 1/2 weeks pregnant. I just drove a whole hour here, like it’s very uncomfortable with my hips to even be in a vehicle. (Participant 4)

Such experiences of inadequate care quality made the financial burden of travel feel particularly unjustified:

[The OBGYN] was way out east, so it took us like $15 in gas or $20 to get there. And when we get there, she would just say, how are you feeling? And I’m like, fine. And she’s like, OK, that’s good. I’ll see you next week… She never measured my belly… She didn’t do any of it, so I just felt that was really kind of pointless… to the point where we just stopped going to the appointments. (Participant 10)

Beyond geographic barriers, participants encountered a variety of informational and navigational challenges that further distanced them from adequate prenatal support. Many recounted difficulties navigating medical services and other forms of support, often due to a lack of information or knowledge about how to access medical care or apply for services, ultimately relying on others for support. These challenges were particularly acute for participants experiencing housing instability:

I had to, you know, get my mom to [make doctor’s appointments] for me because I didn’t know what I was doing… I was with my mom for a little bit and then things went on and I ended up being homeless for a bit. (Participant 8)

Several participants highlighted gaps in navigational support during their interactions with healthcare providers. They expressed the need for more information about the pregnancy and birthing process during routine appointments, which they described as often short and “few and far between.” Moreover, healthcare providers did not always address what one participant referred to as “silly little things,” such as advice on safe foods, exercise routines, and sleeping positions during pregnancy. Participants likewise emphasized their desire for a more proactive approach from their providers, including the provision of general pregnancy-related information and more in-depth discussions about their preferences for pregnancy and birthing care.

… [I]t was my first baby and so you don’t really know the questions to ask… I feel like … they could have been, like, ‘normally at this stage, this is what people are wondering’ and, like, kind of gave more information, would have been really nice. (Participant 3)

These informational gaps had direct financial consequences for participants with limited resources. One participant discovered after giving birth about programs that could have provided financial support during pregnancy:

The whole prenatal vitamin thing was like a really big hassle… I know there’s a program… where you get like free ones from a certain grocery store. I didn’t know that at the time, so that really sucked… it’s really good for moms who can’t really afford the 60 bucks every three months. (Participant 6)

The convergence of geographic distance, limited service availability, navigational constraints, and economic barriers created multiple layers of exclusion that not only left socioeconomically disadvantaged mothers inadequately prepared for optimal prenatal care, but in some cases led them to entirely forgo desired services entirely, ultimately constraining their access to comprehensive prenatal services.

Theme 3: prenatal care experiences amplify the emotional dimensions of pregnancy and birth

Many participants reflected on the emotional dimensions of their pregnancy and birthing experiences, often describing feelings of anxiety and heightened emotions influenced by factors such as housing instability, financial difficulties, lack of family support, or challenges with the healthcare system. For instance, Participant 11 described feeling “extremely upset or really nervous about [the] pregnancy because… I don’t really have much family up here with me and it was just basically me and my partner through it,” and Participant 4 recounted “…the lack of help, the lack of support, even the doctors… how stressful that whole situation with housing was, to not having a place to live and then after the baby, of course you’re going on no sleep.” The financial strain of supporting a household while pregnant created additional emotional burden for some participants:

But it was kind of a really big struggle at first because I was living with my ex at the time and we lived on our own. And I was the only one working, and he had no income, so I was paying for every single bill. And then trying to keep up with my stuff that I need for like my pregnancy, like prenatals and all that stuff… it was challenging. (Participant 6)

For participants dealing with past trauma, pregnancy amplified existing mental health challenges and highlighted the need for therapeutic support. Participant 5 explained:

Because my previous relationship was not the greatest… after I found out I was pregnant, I wanted to make sure that I was in a good place to bring a child in my home because I know a lot of damage was done… my workplace was not the best workplace to me for that, because I had a lot of triggers… I needed to work with the anxiety… because it’s not good for the baby to be too stressed and too anxious… So I see a counsellor to make sure that I was in the best possible mental state to bring that baby boy home. (Participant 5)

While some participants proactively sought mental health support, others felt too overwhelmed to engage with healthcare systems. Participant 7 described her reluctance to access health services during pregnancy because she “felt overwhelmed with everything that was going on during the pregnancy” and did not want to place additional stress on her and her baby. This overwhelm was often compounded by challenging interactions with healthcare providers that amplified their emotional struggles. Participants emphasized how inadequate communication about services or procedures contributed to feelings of stress and uncertainty. For instance, Participant 9 recalled feeling scared during the lead up to her Caesarean section because of not having the proper information communicated to her, stating: “[The healthcare providers] didn’t really, like, describe very much [of the Caesarean section] as they were kind of unorganized. They didn’t really know where a few things were when I was in the room which also made me scared.”

Several participants expressed feeling unheard or invalidated by individual healthcare providers. In a particularly distressing case, Participant 1 described her feelings of indignation and embarrassment after a healthcare provider mocked her request for a waterbirth. Others described feeling pressure from healthcare providers to use specific or unwanted services, thereby undermining their sense of Agency. Participant 1 further recounted that a medical procedure (a membrane sweep) was performed against her consent. For younger participants, this pressure extended to questioning their fitness to parent. Participant 9 recalled feeling extremely uncomfortable after being pressured by her family doctor to consider giving up her baby for adoption:

And [the primary care physician] made me feel so uncomfortable in the appointment. He would constantly ask me if I want to give up my baby for adoption to a family member or someone he knew that can’t have a baby… He would just bring up my baby and be like ‘she’s so young. Maybe she should give the baby to, like, someone that… can’t have a baby’… you can’t try to force them to give a baby away. (Participant 9)

Healthcare providers who took the time to answer participants’ questions and explain the steps and rationale behind specific medical procedures, however, fostered feelings of safety and support throughout the prenatal care process:

Because there is some specialists that are very rude, but [maternal fetal medicine specialist] was so gentle, explained it very well…because some things I did not understand. (Participant 8)

These findings demonstrate how socioeconomic disadvantage intensifies the emotional complexity of pregnancy through multiple pathways. Personal stressors from housing instability, financial strain, and past trauma create a foundation of vulnerability that healthcare system interactions can either alleviate or exacerbate. For participants already managing multiple vulnerabilities, negative provider interactions had particularly profound emotional impacts, while supportive care relationships fostered emotional well-being. The prenatal period thus becomes a critical juncture where systemic inequities either compound existing emotional challenges or offer emotional anchoring.

Theme 4: relational interactions shape prenatal service access and quality

Participants relied on support from friends and family during their pregnancies to access medical and social services, as well as for practical advice and emotional support. This support included help with navigating doctor’s appointments and support groups, as well as guidance throughout the prenatal and birthing periods. Participants explained that connections with friends and family often provided the practical tips and advice they desired but did not always receive from formal healthcare providers. For example, one participant described how she turned to friends with recent birthing experiences for specific guidance: “I had a friend that had her second baby… I asked her what to pack… and what to bring… So the questions about birthing and what to bring to the hospital… I ask her” (Participant 5). Additionally, the seven participants who attended prenatal classes or parenting support groups emphasized the value of these groups for both the information shared and peer support they offered.

However, not all participants had access to consistent family support. Several described limited or absent support from partners and family members. Some noted work-related absences: “Obviously he’s a [profession], so he had to kind of come back and forth and work” (Participant 2), while others experienced abandonment: “I didn’t have a lot of support from the father” (Participant 4). Geographic distance also created barriers, as Participant 1 explained: “I have my family support, but just from phone because my family all lives in [outside of province] and my partner has his family, but they are more excited to have the baby, than support the mother.” This absence of relational support was particularly challenging for participants facing financial constraints, as it removed emotional and material aid: “it was just more like a bunch of not having families for emotional support, financial support for a few months and stuff” (Participant 6).

In the absence of adequate family support, community-based health and social service organizations became important sources of consistent relationships. Staff provided both practical services and emotional continuity that participants valued, fostering trust. By building these relationships, staff acted as a bridge to a variety of different medical and social services:

And it’s like [staff at nonprofit organization] wanna know you on a basis where when you come in, they can talk [to] you about, like, ‘how’s it been since last month’… it’s basically like a family type thing … they just wanna help people out and they try to just be as friendly as possible… it’s been a good experience there because… [they] try to get to know you and your family and try to basically be a part of it. (Participant 11)

Several participants reiterated the importance of provider availability and consistency when accessing or receiving services. Indeed, the easy access and open communication provided by staff members at community-based organizations facilitated feelings of continuity and trust, strengthening participants’ confidence in these providers and their associated services:

I feel like [service provider] just always made sure that there was, like, a line of communication basically, at any time, even if it was, like, 8:00 at night, you could always message her, and she’d do her best to help you no matter what it was. It was just good to have that support. (Participant 10)

These findings reveal how relational factors shape prenatal care access and quality for socioeconomically disadvantaged mothers. When family networks were inadequate, community-based relationships provided crucial substitutes that offered both practical navigation support and emotional continuity. The contrast between absent family relationships and sustained community connections demonstrates that relationship quality - characterized by consistency, accessibility, and genuine care - shapes participants’ capacity to access and benefit from prenatal services.

Discussion

This study contributes to understanding prenatal care experiences of first-time mothers in Atlantic Canada facing vulnerable socioeconomic conditions, focusing on the barriers and facilitators they encountered when accessing care. Four key themes emerged from the analysis: structural challenges and discontinuity disrupt prenatal healthcare delivery; social and physical distance constrain access to prenatal services; prenatal care experiences amplify the emotional dimensions of pregnancy and birth; and relational interactions shape prenatal service access and quality. Participants navigated structural, geographic, and systemic barriers that obstructed their ability to access consistent and quality care [12, 17, 36, 37]. These challenges were compounded by emotional stressors and a lack of navigational support, further exacerbated by the fragmented healthcare systems participants described [38]. Although the New Brunswick HFHB program specifically targets parents in similar circumstances and aims to mitigate healthcare barriers, none of the participants mentioned the program during interviews, suggesting potential gaps in program outreach to socioeconomically disadvantaged first-time mothers. Instead, participants highlighted informal networks, community-based organizations, and prenatal education programs as their primary facilitators of support, information, and care.

Participants in this study navigated a healthcare system fraught with structural inequities that limited their access to adequate prenatal care [39]. Persistent challenges such as lack of access to a family doctor, staff shortages, and long wait times reflect systemic shortcomings that are particularly evident in New Brunswick, where only 51% of citizens with a primary health care provider report being able to access care within five days [40]. These barriers disproportionately affect birthing mothers facing socioeconomic disadvantages [41, 42] which may perpetuate cycles of inequality through less frequent prenatal care and increased risk of obstetric complications [43]. Indeed, findings indicate that participants often turned to alternative sources of care to meet their needs, such as community-based health clinics or nonprofit organizations.

A recurring theme in participants’ experiences was fragmented care, characterized by inconsistent provider interactions, repeated hospital visits without resolution, and frequent relocations within healthcare facilities. This lack of continuity and coordination substantially disrupts quality of maternal care [44] and can delay diagnoses and treatment, increasing the risk of maternal morbidity and mortality [45, 46]. Fragmentation also eroded maternal trust and confidence, which are essential for healthier pregnancies and births [47]. These patterns align with research on first-time mothers who lack prior experience with the healthcare system and thus face additional challenges when navigating fragmented care [39, 48].

Geographic location, particularly rural residence, further compounded these challenges, with participants in rural or remote areas facing additional travel and cost-related barriers due to limited access to nearby birthing facilities or prenatal care providers. Such geographically isolated communities are sometimes referred to as maternity care ‘deserts’ [49] and are associated with elevated risk of maternal morbidity and mortality, including pregnancy-related deaths up to one-year postpartum [50, 51] as well as adverse outcomes such as stillbirth, pre-term birth, and large for gestational age [52]. Indeed, rural participants described the financial burden of travel cost, which created substantial cost barriers, often making care unaffordable for those with lower or unstable incomes [53].

Informational gaps and lack of navigational support further intensified these challenges. Participants frequently described feeling unprepared during routine appointments, citing insufficient information about what to expect and available services. Adequate information about pregnancy care is a critical determinant for continuity of care, such as attending future appointments [54] and helping birthing mothers prepare for the psychological, social, physical, and financial challenges of pregnancy [55]. These gaps left many participants without the knowledge required to navigate the healthcare and social systems independently, echoing findings that providers often assume parents can navigate complex systems without assistance [56].

In response to structural and informational barriers identified in this study, participants frequently turned to informal support networks – friends, family, and online communities – to navigate prenatal care systems. This reliance aligns with research identifying two protective factors for perinatal care: formal support from healthcare providers and informal social support, including family and friends [57]. Informal support networks are major determinants of maternal health outcomes, facilitating the transition to pregnancy and throughout the perinatal phase. Women with such meaningful supports tend to adjust to pregnancy changes and stressors more favourably than those without [58]. These networks provide essential emotional, instrumental, and informational support that enables effective coping with pregnancy-related stress and uncertainty [59, 60].

However, not all participants had access to adequate informal support. Previous research suggests that low-income mothers typically receive less informal support [61] and while many participants in this study had informal networks, some lacked adequate family support and relied on community organizations to compensate for gaps in formal support systems [62]. The absence of adequate family support has been shown to harm maternal health behaviour and outcomes [62]. Women without sufficient informal support networks are less likely to engage positively with prenatal care, adopt healthy behaviours, or experience excitement about childbirth [63, 64] and may be at increased risk for intimate partner violence and postpartum depression [65].

The emotional dimension of prenatal care also emerged as particularly salient for socioeconomically disadvantaged participants. For women already managing multiple stressors, negative interactions with healthcare providers that left them feeling invalidated or pressured had compounding effects, further eroding their trust in the formal healthcare system and potentially deterring future care-seeking behaviours. This finding reflects research demonstrating that negative provider interactions can have lasting effects on maternal mental health and care engagement [66, 67]. Conversely, positive provider interactions – characterized by clear explanations and validation of concerns – alleviated anxiety and fostered therapeutic relationships that extended beyond individual appointments, highlighting the critical role of supportive communication in improving maternal wellbeing [68]. These findings highlight how the quality of provider relationships affects not only the immediate psychological experience of prenatal care but also long-term care and maternal outcomes.

While community-based services were critical in addressing immediate gaps for participants, they often operated with limited resources, lacked integration with formal healthcare systems, and were not always equipped to address the full spectrum of medical and social needs faced by first-time mothers. Consistent with Heaman and colleagues [36] findings from this study highlight the need for expanded community-based services to better meet the needs of birthing mothers who face travel challenges, long waits for short visits, and discontinuity in care delivery. Studies of home-visiting prenatal programs have demonstrated success in overcoming geographic barriers through bridging care directly to mothers in rural and underserved areas [69]. Studies of successful Nurse-Family Partnership programs have demonstrated that continuous relationships with consistent healthcare providers improve outcomes for socioeconomically disadvantaged mothers through relationship-building that begins in the prenatal period [70, 71]. These relationship-based approaches align with the needs that participants described and may warrant consideration as potential models for enhancing prenatal care delivery in New Brunswick [72].

This research has several limitations that should be acknowledged. First, while the inclusion criteria focused on birthing mothers experiencing socioeconomic disadvantage, some participants had higher levels of education, which may have limited our ability to fully capture the barriers faced by those with lower educational attainment. Second, our sample included only English-speaking participants, which does not incorporate the experiences of French-speaking populations in New Brunswick, a bilingual province, or those of newcomers. However, our findings parallel research identifying newcomer and refugee mothers facing similar barriers such as limited social support and unfamiliarity with healthcare services [73, 74]. Third, we did not explicitly ask participants about previous pregnancies that may not have resulted in live births. While no participants mentioned such experiences during interviews, some may have had prior prenatal care exposure that could have influenced their perspectives on care during their current pregnancy journey. Fourth, our recruitment methods may have excluded certain populations experiencing vulnerability, particularly those who do not seek prenatal care, remain disconnected from community-based services, or are unhoused. Despite taking proper steps to build trust with our participants [75] socioeconomically disadvantaged groups may remain wary of research participation, potentially underestimating the complexity of prenatal care challenges among the most underserved populations. Furthermore, our findings reflect experiences within New Brunswick’s specific healthcare context and may not transfer to provinces with different service delivery models or geographic constraints. The cross-sectional design captured a snapshot of experiences rather than tracking evolving needs throughout pregnancy. Additionally, retrospective accounts may be influenced by subsequent birth outcomes or care experiences.

Conclusion

This study elucidates the prenatal care experiences of first-time birthing mothers exposed to socioeconomic disadvantage, highlighting the barriers and facilitators that shaped their access to prenatal care. Findings highlight how multiple disadvantages compound during pregnancy, as participants faced systemic challenges including fragmented care, geographical constraints, and inadequate navigational support, which collectively limited access to consistent care. Informal networks and community-based organizations play a key role in bridging gaps, providing resources, and fostering trust where formal systems fell short. Addressing these disparities requires integrated public health approaches that coordinate care across providers and settings, expand geographic access to services, and prioritize equity in birthing parents’ healthcare experiences. Further research should examine the experiences of diverse and underserved populations, including newcomers, racialized and Indigenous peoples, and those at the intersection of multiple vulnerabilities, to better inform efforts toward inclusive and effective prenatal care systems. Given the rural healthcare challenges and socioeconomic context of the region, implementing these changes is particularly important in New Brunswick, where addressing barriers to prenatal care could significantly improve maternal and infant health outcomes.

Abbreviations

HFHB

Health families, healthy babies

FRCs

Family resource centres

REB

Research ethics board

Authors’ contributions

SM conceptualized and led the study design. JC contributed to the study design. HS and SM facilitated connections with Family Resource Centres and other community organizations. MS, HS, LW, and CR conducted the interviews, and LW and CR performed the analysis. MS and LW drafted the manuscript in consultation with SM. MS conducted revisions in consultation with coauthors. All authors reviewed, provided critical revisions, and approved the final manuscript.

Funding

This project was funded by Research New Brunswick (RNB) and the Maritime SPOR Support Unit (MSSU). The funders had no role in the study design, data collection, analysis, interpretation of data, writing of the report, or the decision to submit the article for publication.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Ethics was approved by the University of New Brunswick – Research Ethics Board (Ref Number: #2023 − 116).

Informed consent was obtained from all participants after they were provided with detailed information about the study’s purpose, procedures, potential risks, and benefits. Participants were given the opportunity to ask questions and voluntarily agreed to participate. Informed consent was obtained via consent form filled and completed prior to interview. Participants verbally reiterated their consent at the beginning of the interview.

The study adhered to the ethical principles outlined in Canada’s Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans – TCPS 2 (2022). Consent was followed based on Chap. 3: The Consent Process. Privacy was safeguarded through the anonymization of data and secure storage, ensuring compliance with Chap. 5: Privacy and Confidentiality, Article 5.1, 5.2, 5.3, and 5.4. The study followed protocols outlined in Chap. 10: Qualitative Research. All research activities were reviewed and approved by the Research Ethics Board (REB) prior to data collection.

Consent for publication

Consent for publication was obtained from participants, including their demographic information.

Competing interests

The authors declare no competing interests.